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Chronic Venous Insufficiency
may result from DVT and/or valvular incompetence Pathophysiology
DVTCause valve leaflets become thickened and contracted so that they cannot prevent retrograde flow of the blood
The vein becomes rigid and thick walledSecondary incompetence develops in distal valves because high pressures distend the vein and separate the leaflets
Primary deep venous valvular dysfunction may also occur without previous thrombosis
Clinical Featureso Dull ache in the leg that worsens with prolnged standing and resolves with
leg elavationo Increased leg circumference, edema o (+) superficial varicose veinso (+) eryhtema, dermatitis and hyperpigmentation develop along the distal
aspect of the lego skin ulceration may occur near the medial and lateral malleolio cellulites may be a recurring problem
Managemento Patients should be advised to avoid prolonged standing or sittingo Frequent leg elevationo Graduated compression stockings shoud be worn during the dayo Ulcers
Wet to dry dressings Dilute topical antibiotic solutions Surgical interruption of incompetent communicating veins – for
recurrent ulceration and severe edema Surgical vavuloplasty Bypass of venous occlusions